Michigan Laws 550.1837 – Autism coverage fund; creation within state treasury; investment; credit of interest and earnings; administration of fund by department for auditing purposes; expenditures; reimbursement; insufficient
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Terms Used In Michigan Laws 550.1837
- Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Carrier: means any of the following:
(i) An insurer or health maintenance organization regulated under the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.1833Department: means the department of licensing and regulatory affairs. See Michigan Laws 550.1833 Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006. Fund: means the autism coverage fund created in section 7. See Michigan Laws 550.1833 Paid claims: means actual payments, net of recoveries, made for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders whether made to a provider or reimbursed to an individual by a carrier, third party administrator, or excess loss or stop loss carrier. See Michigan Laws 550.1833 program: means the autism coverage reimbursement program created under section 5. See Michigan Laws 550.1833 state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o Third party administrator: means an entity that processes claims under a service contract and that may also provide 1 or more other administrative services under a service contract. See Michigan Laws 550.1833
(1) The autism coverage fund is created within the state treasury.
(2) The state treasurer may receive money or other assets from any source for deposit into the fund. The state treasurer shall direct the investment of the fund. The state treasurer shall credit to the fund interest and earnings from fund investments.
(3) The department is the administrator of the fund for auditing purposes. The department shall expend money from the fund, on appropriation, only for the purpose of creating, operating, and funding the program.
(4) Except as otherwise provided in subsection (7), the department shall reimburse carriers and third party administrators from the fund in the order in which the applications are approved under the program. If there is insufficient money in the fund to reimburse a carrier or third party administrator for paid claims approved under section 5, reimbursement must not be made. However, applications that are approved but not reimbursed may be paid if revenues of the fund become available.
(5) The department shall develop and implement a process to notify carriers, third party administrators, and the legislature that funds in this program may be insufficient to cover future claims when the department reasonably believes that within 60 days the funds in the program will be insufficient to pay claims. The process shall, at a minimum, do all of the following:
(a) Identify a specific date by which carriers and third party administrators will no longer receive reimbursement for claims submitted to the program.
(b) Outline a clear process indicating the order in which claims pending with the program will be paid.
(c) Outline a clear process indicating the order in which claims that were pending with the program when funds became insufficient will be paid if funds subsequently become available.
(6) Money in the fund at the close of the fiscal year shall remain in the fund and shall not lapse to the general fund.
(7) Subject to subsection (8), from money appropriated to the fund in calendar year 2016, the department shall reimburse a carrier or third party administrator for a paid claim approved under section 5 pursuant to the formula under subsection (8) if the following conditions are met:
(a) The carrier or third party administrator submits its application under section 5 before May 1, 2016.
(b) The services for which the carrier or third party administrator is seeking reimbursement were provided before January 1, 2016.
(c) The department has not already fully reimbursed the carrier or third party administrator for the paid claim.
(d) The department approves the paid claim of the carrier or third party administrator before August 1, 2016.
(8) The department shall reimburse a carrier or third party administrator under subsection (7) pursuant to the following formula:
(a) First, divide the money appropriated to the fund in calendar year 2016 by the total paid claims approved under section 5 that meet the conditions under subsection (7).
(b) Second, multiply the calculation under subdivision (a) by the amount of the carrier’s or third party administrator’s paid claims approved under section 5 that meet the conditions of subsection (7).